Miami Ranks #1 on List of Banned Medicare Providers By Tod Aronovitz | 04/25/14 | 0 Comment

Miami reigns supreme in yet another category of healthcare fraud: Medicare’s list of banned providers.

According to a McClatchy News Bureau analysis, of the 57,000 entries in the federal government’s “exclusions database,” there are 1,491 people and entities listed with Miami addresses.

This database of Medicare providers, which the federal government maintains to provide information to the public, aims to stem further Medicare fraud and abuse. Individuals and businesses listed are currently banned from participating in Medicare, Medicaid and all other federal health care programs.

No other location comes close to Miami in terms of banned Medicare providers. The next cities in line are Los Angeles (522 listings), followed by Phoenix, Brooklyn, N.Y., and Houston, an April 23 McClatchy article revealed.

Louis Saccoccio, the chief executive officer of the National Health Care Anti-Fraud Association, attributed the high exclusions in Miami to greater law enforcement in that Medicare fraud hotspot.

“In some places, you’ve seen an explosion in healthcare fraud: in Miami, Houston, Detroit, Southern California. And there is more aggressive law enforcement there. They’re getting convictions, and they’re getting exclusions,” he relayed in the article.

Those convicted of healthcare fraud show up in the database with the last address Medicare had for them. The ZIP code with the federal prison in Miami tops any other ZIP codes in the nation.

Although those addresses make up less than one-fourth of the Miami entries in the database, another item to note is that some criminals convicted of Medicare fraud in Miami are housed in federal prisons in other states. Consequently, they are not counted in Miami’s total of banned Medicare providers.

In some cases, Florida’s database statistics don’t follow the national trend.

For example, the largest share of people and businesses in the database—44 percent—are there because they’ve had their medical licenses revoked. The next biggest share—27 percent—of listings are there because of crimes related to Medicare and Medicaid.

However, those results are reversed in the Sunshine State. The leading cause of making the exclusion database in Florida is due to Medicare- or Medicaid-related crime at 38 percent. Having a license taken away ranked next, at 34 percent.

U.S. Sen. Bill Nelson, D-Fla., indicated the large number of retirees in the state, and therefore, Medicare beneficiaries, as one reason this type of healthcare fraud proliferates. He also suggested the changing face of long-term criminal elements that have altered their unlawful tactics to less violent crimes.

Brian Martens, a federal healthcare fraud investigator who helps oversee the Medicare fraud strike force in Miami and has seen it grow from four teams in 2007 to its current 11 teams, has found Miami’s type of Medicare fraud “more egregious in nature” than in the rest of the country.

In other states, a doctor might treat somebody and tack on a little something extra to the Medicare claim, he said, but “here, they’re having your mom sign some forms and she’s never gotten anything at all.”

How to Report Miami Medicare Fraud

Healthcare professionals or medical billing employees who have knowledge of questionable Medicare billing practices can file a confidential legal claim under the False Claims Act. By acting as a “whistleblower” in what is known as a “qui tam” lawsuit, a private party may collect between 10 to 30 percent of the amount recovered, depending on how the case is prosecuted.

ARONOVITZ LAW: Miami Whistleblower / Qui Tam Law Firm

The Miami Qui Tam law firm of ARONOVITZ LAW routinely works with whistleblowers to document Medicare fraud and other forms of fraud against the government. Contact Miami Whistleblower / Qui Tam lawyer Tod Aronovitz to discuss your case.